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Cardiac magnetic resonance depiction of left ventricular cardiomyopathy secondary to roundworm infection

Onkar B Auti, Arul Narayanan, Vimal Raj

Background: Cardiac manifestations of hyper-eosinophilia can have high morbidity with about 40-50% of patients having signs and symptoms of cardiac diseases. We present a case of Hyper- Eosinophilic Cardiomyopathy (HEC) due to Strongyloide Stercoralis (S. Stercoralis) infection with its characteristic Cardiac Magnetic Resonance (CMR) appearances.

Case presentation: An adult female underwent CMR for evaluation of LV dysfunction. At the time of examination, she had peripheral eosinophilia and had a positive history of Strongyloide infection. CMR showed moderate LV dysfunction with LVEF of 43%. The myocardium demonstrated a ‘wavy’ appearance with multiple focal areas of thinning and intervening normal segments. There was diffuse subendocardial enhancement on Late Gadolinium Enhancement, which did not fit any vascular territory.

Conclusion: CMR imaging is a useful tool in assessment of HEC by providing early diagnosis. HEC can also occur due to parasitic infection such as Strongyloide (roundworm) and may demonstrate unique/characteristic appearances of the myocardium on CMR.